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New AFib Diagnosis Could Increase Cognitive Impairment, Including Dementia

An atrial fibrillation (AFib) diagnosis was associated with an increased risk of mild cognitive impairment (MCI) and progression to dementia, according to a study published Oct. 25 in JACC: Advances.

Sheng-Chia Chung, PhD, et al., used the UK primary electronic health record (EHR) data of 4.3 million individuals to investigate the association between AFib and MCI and subsequent dementia. AFib was defined as I48 of the International Statistical Classification of Diseases-10th Revision (ICD-10) and corresponding Read version 2 terms (Read V2) from the Clinical Practice Research Datalink. The primary outcome of the study was the incidence of MCI, defined as ICD-10 codes G31.8 and F06.7 and corresponding Read terms.

The mean age of the study cohort was 74.2 years and there were 4,269 total incident cases of MCI over the median 5.3-year follow-up.

Results showed that AFib was associated with a 45% increase in the risk of MCI, specifically in those with older age, female sex, higher socioeconomic deprivation, clinical history of depression, stroke and multimorbidity. However, these factors did not modify the link between AFib and MCI. For individuals over 74 years old, AFib and MCI were frequently diagnosed when multicomorbidity was detected, including diabetes, depression, hypercholesterolemia and peripheral artery disease.

During follow-up, 1,117 individuals were diagnosed with dementia on or after a diagnosis of MCI. AFib was linked with a higher risk of dementia among those who had developed MCI. Sex, asthma, smoking, chronic kidney disease and multi-comorbidity were associated with an elevated subsequent dementia risk.

Patients with AFib who were treated with digoxin did not experience an increased MCI risk. The risk of MCI was higher in patients with AFib who did not receive oral anticoagulant treatment and amiodarone treatment. Similarly, patients with AFib who received oral anticoagulant treatment and amiodarone treatment were not at risk of MCI.

The authors note that, “progression from MCI to dementia appears to be, at least partially, mediated by cardiovascular risk factors and the presence of multiple comorbidities,” and that these findings suggest that integrated AFib care, such as combining anticoagulation and comorbidity management, could help prevent cognitive deterioration and the progression to dementia.

Clinical Topics: Arrhythmias and Clinical EP, Atherosclerotic Disease (CAD/PAD), Atrial Fibrillation/Supraventricular Arrhythmias, Sleep Apnea

Keywords: Peripheral Arterial Disease, Dementia, Digoxin, Atrial Fibrillation

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